Objective:To investigate the significance of sleep electroencephalogram (EEG) monitoring in the diagnosis and differential diagnosis of childhood epilepsy.Methods:The clinical data of 56 children with epilepsy diagnosed in The Maternal and Child Health Hospital of Huainan from February 2020 to February 2022 were retrospectively analyzed. The relationship between the positive rate of epileptiform discharge under sleep EEG monitoring and its location and sleep phase was analyzed.Results:Of the 56 children, 36 (64%) children had normal results of routine awake EEG monitoring, and 20 (36%) children had abnormal results. Among the 56 children, 9 (16%) children had normal sleep and 47 (84%) had abnormal sleep. The difference in EEG monitoring results between the awake and asleep states was statistically significant ( χ2 = 27.08, P < 0.001). Among abnormal EEG in 47 patients, paroxysmal abnormality (epileptiform discharge) was found in 44 patients and non-specific abnormality was found in 3 patients. Among the 44 children with epileptic discharges, 5 (11%) had epileptic discharges during wakefulness, 11 (25%) children had epileptic discharges during a sleepless period, and 28 (64%) had epileptic discharges during a slight sleep period. EEG epileptiform discharges occurred in the central temporal region in 9 (21%) patients, temporal region in 8 (18%) patients, parieto-occipital region in 1 (2%) patient, frontal region in 5 (11%) patients, and the frontotemporal region in 6 (14%) patients. Generalized discharges were found in 14 (32%) patients, and generalized hypsarrhythmia was found in 1 (2%) patient. Conclusion:Children with clinically highly suspected epilepsy should be reexamined by sleep EEG if the routine awake EEG, monitoring results are normal, to reduce the rates of misdiagnosis and missed diagnosis in children with epilepsy.

Objective:To investigate the correlation between adverse events and antiplatelet drug resistance after neurovascular intervention for cerebrovascular stenosis.Methods:A total of 148 patients with cerebrovascular stenosis who underwent neurovascular intervention at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to December 2020 were included in this study. The platelet function of patients before and 24 hours after antiplatelet drug treatment was recorded. Platelet drug resistance was analyzed. At 3, 6 months, and 1 year after neurovascular intervention, adverse events were recorded through follow-up. The patients were divided into the occurrence group and the non-occurrence group according to whether adverse events occurred or not using the case-control study method. The Spearman correlation coefficient was used to analyze the correlation between adverse events and antiplatelet drug resistance after neurovascular intervention for cerebrovascular stenosis.Results:After 1 year of follow-up, among the 148 patients, 29 patients lost their follow-up, and 119 were included in the final analysis. Of the 119 patients, 41 patients had adverse events and 78 patients had no adverse events. In the occurrence group, the expression levels of platelet membrane glycoprotein P-selectin and platelet activating complex were (20.22 ± 6.33)% and (68.80 ± 11.52)%, respectively, before drug treatment, and they were (15.77 ± 4.12)% and (43.19 ± 5.90%)%, respectively, after drug treatment, all of which were significantly higher than those in the non-occurrence group [before drug treatment: (16.85 ± 3.24)%, (62.34 ± 10.77)%, after drug treatment: (8.31 ± 2.97)%, (35.85 ± 5.14)%] (before drug treatment: t = 3.20, 2.97, both P < 0.05; after drug treatment: t = 10.28, 6.74, both P < 0.05). The incidences of aspirin resistance and clopidogrel resistance in the occurrence group were 51.2% (21/41) and 43.9% (20/41), respectively, which were significantly higher than 26.9% (8/78) and 19.2% (9/78) in the non-occurrence group ( χ2 = 24.47, 20.23, both P < 0.001). Spearman correlation analysis showed that both aspirin resistance and clopidogrel resistance were moderately positively correlated with adverse events after neurovascular intervention ( r = 0.45, 0.41, both P < 0.05). Conclusion:Adverse events after neurovascular intervention are moderately positively correlated with resistance to the antiplatelet drugs aspirin and clopidogrel.

Objective:To investigate the effects of perioperative intracranial pressure monitoring-guided treatment on cerebrospinal fluid brain-derived neurotrophic factor (BDNF) and S100B protein levels, and prognosis in patients with severe traumatic brain injury.Methods:A total of 84 patients with severe traumatic brain injury who received treatment at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2015 to August 2020 were included in this case-control study. These patients were divided into a study group ( n = 48) and a control group ( n = 36) based on different treatment methods. The control group was treated with routine treatment, while the study group underwent perioperative intracranial pressure monitoring-guided treatment. Clinical efficacy, BDNF, S100B protein, and prognosis were compared between the two groups. Results:The total effective rate in the study group was 87.5% (42/48), which was significantly higher than 69.4% (25/36) in the control group ( χ2 = 4.15, P = 0.042). After treatment, the BDNF level [(0.181 ± 0.021) μg/L] in the study group was significantly higher, and S100B [(4.3 ± 1.8) μg/L] level in the study group was significantly lower, compared with the control group ( t = 3.09, -4.86, both P < 0.001). The poor prognosis rate in the study group was 47.9% (23/48), which was significantly lower than 69.4% (25/36) in the control group ( χ2 = 3.89, P = 0.048). According to patient prognosis, these patients were divided into a good prognosis group and a poor prognosis group. The intracranial pressure level of patients in the poor prognosis group was significantly higher than that in the good prognosis group ( t = 4.12, P < 0.001). The area under the curve of intracranial pressure level for evaluating prognosis in patients with severe traumatic brain injury was 0.880 (95% CI: 0.809-0.950, P < 0.001). Conclusion:Perioperative intracranial pressure monitoring-guided treatment can greatly improve the levels of cerebrospinal fluid BDNF and S100B in patients with severe traumatic brain injury and improve the prognosis.

Objective To identify prognostic factors ofmotorfunctionafter surgery of metastatic spinal cord compression (MSCC).Methods The clinical data of 681 patients with spinal metastases from January 2008 to December 2017 were retrospectively analyzed.According to inclusion and exclusion criteria,a total of 206 patients with spinal metastatic were included.Postoperative neurological function was assessed using Frankel classification.The influence of age,gender,preoperative status,number of spine metastases,location of spinal metastases,visceral metastases,bone metastases,primary tumor type,interval from symptom to surgery,time of developing motor deficits,interval from primary tumor diagnosis to MSCC,preoperativethe Eastern Cooperative Oncology Group performance status (ECOG-PS),Karnofsky Performance score (KPS) and surgical procedures on postoperative function outcomes were explored.Results 140 (68.0％) patients were able to walk postoperatively compared with 88 (42.7％) patients preoperatively.Moreover,in 89.8％ of all patients,79 ambulatory patients maintained ambulation after treatment.The univariate analysis according to Ordered-logit model showed thatnumber of spine metastases,location of spinal metastases,preoperative ECOG-PS,preoperative KPS,interval from symptom to surgery and time of developing motor deficits were related with posttreatment motor functions.The multivariable analysis showed that number of spine metastases (OR=2.03;95％CI:1.12-3.33;P=0.04),preoperative ECOG-PS (OR=4.84;95％CI:2.42-8.15;P=0.038),interval from symptom to surgery (OR=3.78;95％CI:3.12-9.15;P=0.024),time of developing motor deficits(OR=2.75;95％CI:1.22-3.89;P=0.01) were independent prognostic factors for function outcomes.Conclusion 1-2 levels of metastasis,Interval from symptom to treatment ≥ 48 h,time of developing motor deficits ≥7 d,and ECOG-PS 1-2 can be considered as the most significant positive prognosticfactors for post-treatment ambulatory status.Spinal metastasis should have a higher priority,and immediate intervention should be started before the development of irreversible neurologic deficits.Increasing awareness of early symptoms and earlier screeningwith regular outpatient review might make a difference for patients with MSCC.Consequently,the identified prognostic factors can be considered as apreoperative assessment tool to predict the neurologic outcomeand guide clinical treatment for individual patients with MSCC.

Refractory angina is characterized by recurrent and persistent angina with a duration of not less than three months， which is related to reversible ischemia and hypoxia caused by coronary stenosis and obstruction. It mainly involves obstructive coronary artery disease and non-obstructive coronary artery disease with coronary artery spasm and coronary microvascular dysfunction. “Stasis and toxin” play an important role in the pathogenesis of cardiovascular diseases. The pathogenesis of stasis and toxin is stubborn filthy turbidity featured by slow accumulation and sudden onset，and rapid changes，which coincides with the characteristics of refractory angina which is complex and changeable，prolonged and difficult to cure. The pathogenesis of refractory angina involves a combination of underlying deficiency and excessive manifestation， with "stasis and toxin" playing a crucial role as an important pathological factor in the whole process of refractory angina. Traditional Chinese medicine （TCM） employs a holistic approach known as "activating blood circulation and removing toxins"， which is supplemented by various methods to tonify Qi and warm Yang， nourish the kidneys and invigorate the spleen， clear heat and transform phlegm. This approach applies anti-inflammatory measures， regulates lipid metabolism， inhibits oxidative stress and thrombus formation， protects endothelial function in blood vessels， as well as establishes collateral circulation for the prevention and treatment of refractory angina. Therefore，based on the theory of "stasis and toxin"，combined with TCM theory and modern medical research，this paper discusses the pathogenesis of refractory angina and the prevention and treatment strategy of TCM，and elucidates the reasons for the difficulty in curing refractory angina and the relationship between refractory angina and common angina pectoris，coronary microvascular dysfunction，coronary artery spasm and obstructive coronary artery disease，hoping to provide certain theoretical basis and clinical ideas for the prevention and treatment of refractory angina with TCM.